Despite ever-changing trends and the latest celebrity endorsements of questionable treatments or untested products, topical vitamin A is an industry stalwart that’s long proven its worth as an effective anti-ageing skin treatment, writes Dr Edward Berry.
The anti-ageing revolution is seriously on the go, with a new expert imparting their advice every couple of months about the latest treatment modalities with injectables, procedures, fasting modalities and new molecules for both oral and topical use.
Never has the market been more saturated with topical applications, all promising to reverse the process of ageing… or at least slow it down tremendously.
For those who are fortunately in the know, there have always been only a few molecules which has been tried, tested, and found to be of value … both from a medically sound and a scientific point of view.
These molecules, specifically the vitamin A derivatives such as tretinoin (all-trans retinoic acid), have been on the market for more than five decades, and are still regarded as the number one choice by dermatologists for turning back the photo-ageing and anti-ageing clock.
Now, because retinoids help your skin to make more collagen, they can effectively soften wrinkles and fine lines. These molecules also stimulate new blood vessels that, together with the thickening of the dermis, provide one with a youthful and glowing complexion. What’s more, retinoids assist in the fading of age spots, while smoothing out rough patches.
It’s a kind of magic
The term ‘magical molecule’ comes from the effect these molecules have on the retinoic acid receptors. Binding to these receptors induces gene expression that leads to cell proliferation and decreased cell differentiation. The inhibition of telomerase also leads to shortening of the telomere and cell death of tumour and ageing cells.
It is for all the above reasons that tretinoin should be used as your skin matures and deteriorates over time.
The retinoids are derived from vitamin A and were first prescribed and used for acne. They remain remarkably effective to this day and should be included in the management of almost all types and severity of acne… either as a standalone drug or in combination with other topical and oral medications.
It is important to note that tretinoin can take up to 12 weeks to work effectively and there might be worsening in the acne for the first couple of weeks. This is known as the tretinoin purge and the standout signs are dryness and flaring of the acne. This phase can continue for up to six weeks but usually lasts no longer than three. With gentle persuasion, most people will continue with the treatment if their prescribing doctor is knowledgeable and understanding.
Tretonoin usage
The use of tretinoin in acne is well described and researched. It is known to stabilise keratinisation and decrease follicular proliferation.
The retinoids are indicated and most commonly used for acne and as an anti-ageing treatment; however, conditions such as psoriasis, keratosis pilares, ichthyosis, stretch marks and keloids, among others, are also treated. A novel field is the use of tretinoin in malignancies such acute promyelocytic leukaemia.
The natural retinoids are derived from vitamin A but newer synthetic retinoids, such as etretinate, are also found. Both natural and synthetic retinoids trigger certain receptors in the skin and there is not a correct answer to which group is better. The synthetic group might trigger fewer receptors, being less active in the short run; however, but they may be better tolerated. Your skincare or anti-ageing practitioner would and should be able to guide you in the use of correct retinoid.
Formulations
In topical form, vitamin A derivatives can be pro-retinol, retinol or the more active retinoids. It is important to note that tretinoin is a prescription drug, as it is 20 times stronger than retinols. There are also different strengths of tretinoin (i.e. 0.025 and 0.05). The different strengths can also be incorporated in either gel or cream form.
The choice between gel and cream will be dependent on factors such as indication for use, as well as environmental factors, including atmospheric humidity and the season. The gel contains a higher percentage alcohol and, in theory, is more drying and irritating. It can, however, be the formulation of choice for oily, acne-prone skin, while ageing skin will need more moisture and therefore a cream will be of value. A dryer environment such as the Northern Cape will probably necessitate the use of a cream while an area such as the Natal Coastline will favour the use of a gel.
Stronger formulations work better but should be discussed with patients, as irritation can occur. The side effects are almost always something that can be managed, as they pass quite quickly. A practical way of managing the drying effect is to apply a moisturiser an hour after the application of tretinoin.
In my practice, I prefer the use of 0.05% tretinoin, so as to achieve maximum results as soon as possible. The side effects are negated by using it initially every second night and combining it with a good, hydrating moisturiser. Be careful not to use high concentrations of AHA and PHA products in combination, as these can lead to irritation and even dermatitis of the affected skin.
Retinoids should also be used at night only, as all vitamin A derivatives are potent sun sensitisers and can cause discomfort when exposed to the sun or bright lights.
Take-home message
No anti-ageing regime is complete without the use of retinoids and the 0.05% tretinoin is the treatment of choice for the vast majority of dermatologists.
The question that the client should ask is not why this product or that product, but rather, why have I not been prescribed a retinoid?
Disclaimer: This article was commissioned by Rite Aid Health Care. Content is written by Dr Edward Berry, whereby he shares his professional experience, knowledge and thoughts on the use of topical tretinoin for the treatment of various skin concerns. Rite Aid is the distributor of medical-grade retinol in South Africa available by prescription only. Due to medical regulations in South Africa, we are unable to publish the names of scheduled medicines. Contact Rite Aid for more info (+27) 011 325 2686 / info@riteaid.co.za or speak to your doctor.
MMed (Derm), MBChB, BSc, Founder of Skin Creations